www.england.nhs.uk

Long Term

Conditions

Lunch & Learn

Clinical input to care homes

with Nicola Spencer and

Emily Carter - NHS England

20 January 2016

www.england.nhs.uk

LTC Framework

Commitment

to Carers

Frailty

Health Ageing

Guide

Fire Service as

an asset

Care Homes

Quick Guides

Care & Support

Planning

Navigating Health

& Social Care

Self Care

Ambitions for

End of Life Care

Our Declaration

Delivery Models

Planning for Change:

• Capitated Budget

• Contracting

• Simulation Modelling

Patient and

Service

Selection

Planning for Change:

Workforce

Whole Population

Analysis;

Understanding your

population

LTC Dashboard LTC Toolkit

www.england.nhs.uk

Long term conditions resources

Simulation model

Unbundling recovery simulation model

www.england.nhs.uk

7

Using behavioural

change to open minds

#A4PCC – Action for Person-Centred Care

Person with

long term

condition

o Make a declaration at

www.engage.england.nhs.uk/survey/ltc

-declaration

o Tell your teams about our work

o Encourage them to make a declaration

o Ask them to feed back thoughts and

ideas

o Use our hashtag – #A4PCC – when

you see work that is relevant to

person-centred care for people with

LTCs

o Let us know of any events, activities or

social media opportunities that we can

join forces with you

www.england.nhs.uk

Date Topic Led by and details of session Venue

10 February

11.30am

Health Coaching in the community-

the role of non-clinical staff and

people with lived experience as

coaches

Anya De Iongh & Jim Phillips Via WebEx

TBC Self-management in the community

and on the Internet

Peter Moore, The Pain Toolkit Via WebEx

LTC Virtual Learning Community Lunch & Learn webinars:

Sharing and Learning …

www.england.nhs.uk

Long Term

Conditions

Lunch & Learn

Clinical input to care homes

with Nicola Spencer and

Emily Carter - NHS England

20 January 2016

www.england.nhs.uk

Nicola Spencer

Programme Support Manager- End of Life Care

NHS England

Emily Carter

Assistant Head of Planning Delivery

NHS England

Quick Guide: Clinical Input Into Care

Homes

www.england.nhs.uk

• Published series of quick guides to support local health and care systems.

• Practical tips, case studies and links to useful documents, which can be

used to implement solutions to commonly experienced issues.

• The guides will:

• bring clarity on how best to work with the care sector

• help you to find out how people across the country are working to

reduce unnecessary hospital admissions/delayed transfers of care

• break down commonly held myths, i.e. sharing patient information

across integrated care teams and continuing healthcare assessments

• allow you to use other people’s ideas and resources

• enable you to breakdown barriers between health and care

organisations

Overview of Work

www.england.nhs.uk

• The Quick Guide we’re going to talk to you about

today is: Clinical input into care homes.

• http://www.nhs.uk/quick-guides

www.england.nhs.uk

Some facts and figures

about this cohort – what we

know

www.england.nhs.uk

3 million aged

80+ - projected to

double in the

next 30 years

Majority of residents

living with complex

co-morbidities

16% of people

aged 85+ in the

UK live in a care

home

Median period from

admission to the

care home to death

is 15 months

> 75% of people living in

care homes in England,

Wales and NI have

dementia/severe memory

problems

Two thirds of residents –

immobile/or in need of

assistance; two thirds

are incontinent

Median number of

medications per

resident is 9

No common framework for

describing the differing

services and staffing

20-30% of

ambulance calls

from care homes

are due to falls in

the elderly Workforce issues

www.england.nhs.uk

• Experience difficulties accessing the right care at the

right time.

• Same rights to care as the rest of the population - but

frequently suffer

• Improving the clinical input into a home and tailoring

care around the diverse needs of individual residents

can improve the quality of care and quality of life for

people, and reduce unnecessary hospital admissions.

Care homes… Setting the Scene

www.england.nhs.uk

• Worked collaboratively with stakeholders across different

settings to develop this Quick Guide - comprises of case

studies, ideas and practical tips on how to improve the clinical

care for people living in care homes for commissioners and

providers.

• The contents – to be taken as pragmatic recommendations to

support local health/social care systems;

• Not mandatory; and should be read alongside the other Quick

Guides: Identifying Local Care Home Placements’ and

Technology in Care Homes.

Quick Guide: Clinical Input Into Care

Homes

www.england.nhs.uk

• Building effective relationships

• Multi-Disciplinary Team (MDT) working

• Enhancing nursing therapies

• How to improve general practice input into care homes

• Medicines management

• Supporting people with dementia

• How to improve oral health, hydration and nutrition in care homes

• Improving end of life care

• Harnessing technology

• Promoting health and wellbeing

• Supporting and upskilling staff

The Quick Guide Focusses on

Several Key Areas:

www.england.nhs.uk

Embedded links throughout to useful documents, e.g.:

• Cornwall’s suite of clinical management tools

specifically developed for care homes

• North & East Hertfordshire’s single intermediate care

pathway

• North Staffordshire’s funding formula for GP services

in care homes

• Sheffield’s service specification for community

pharmacy in care homes

Full of Useful Resources

www.england.nhs.uk

• Part of longer term work to improve the clinical input into care homes - led by NHS England in partnership across the health and care system

• Link to the care home van guards to ensure learning and models shared across the country

• Work plan for 2016/17 in development as part of the Independent Care Sector Programme

• Introduce you to colleagues who are leading on two of the initiatives featured in the guide………

Next Steps

QUEST4CARE

Supporting care homes to perform

Developed in partnership with

Why?

Builds on our commitment and experience of working with the NHS as the largest provider

of audit, governance and risk services;

Recognise the need for better data and effective benchmarking across care home sector;

Utilises our in-house expertise of building and running governance software products and

benchmarking clubs;

Genuine desire to help our clients gain better oversight and management controls within

the sector; and

18

Who are RSM UK

RSM UK is one of the three principal mid-market professional services firms, with almost

3,500 partners and staff generating a fee income of over £300 million.

Work with over 650 public sector clients

Provide Internal Audit to over 90 NHS organisations

RSM Software Solutions is our in-house software development team

Our software clients include NHS, Local Authorities, Education and private sector

Total licensed users of our products is over 95,000 users

19

What is it?

Web-based, periodic self assessment questionnaire accessible on PC, smartphone or

tablet;

Intelligent branching of questions;

In built web links to good practice websites and national/local CCG policies;

Weighted scoring of questions to create RAG reporting across each domain;

Enables comparison across cohorts of care homes; and

Fully flexible reporting which allows trend, peer group and comparison reporting via

standard and bespoke reports.

20

The Questionnaire

21

• Resident flow;

• Inspection regimes;

• Students;

• Audits; and

• Recruitment process for staff.

22

The Questionnaire

23

• Pressure ulcers management;

• Falls prevention;

• Medication management;

• Adult safeguarding;

• Hospital avoidance; and

• Admission strategies.

The Questionnaire

24

• Presence of policies/protocols and

• Induction/on-going training

• Nutrition and hydration;

• Infection control;

• Management of continence;

• Aseptic technique;

• VTE;

• End of life;

• Advanced care practice;

• Loneliness; and

• Individualised care plans.

The Questionnaire

– .

25

• Resident feedback;

• Feedback; and

• Carers, relatives and other feedback

• Staff feedback

The Questionnaire

26

• Care;

• Compassion;

• Competence;

• Communication;

• Courage; and

• Commitment.

The Questionnaire

27

• Working with CCGs so that pre-registration students can have placements in Care Homes

• Working with GPs so that they have drop in clinics, ward rounds and also pencil in 6 monthly reviews of all residents

• The developing of Reablement Suites

• Working with CCGs so that pre-registration students can have placements in Care Homes

• Working with CCGs to offer mentorship training to staff

• Supporting Care Homes that have asked for assistance for certain policies and training

• Conversations over bed management, where are the vacancies, experienced staff able to take complex patients

• Care Homes offering to revamp their offering, ring fencing beds and recruiting more staff

• Care homes offering to give staff extra training to take complex patients

• Reablement, using Care Homes bed to support patients with OT and Physio support to get them back home

The Questionnaire

CCGs 2015

York CCG

Has woven Quest4Care into their well-established Care Home Forum and uses the results to promote

dialogue and discussion. They have been working with particular homes to commission reablement beds

with an impressive average bed stay of 9 days from hospital, to care home and then to their own home. One

individual home has kept 66 patients out of hospital.

NHS Kernow

The CCG launched the tool on the 1st of November with a return rate of 90%. They have selected a cohort

of homes to go through the first tranche and are working towards Quest4Care being part of their contracting

assurance process. The Care Homes have signed up to a peer group taking part in the first cohort and

already one of the Care Homes has volunteered and been accepted to have a staff member as a Care

Maker. In addition, even at this early stage, several homes have made contact with the HEI to push to have

students in their homes as part of a wider co-ordinated drive around recruitment and retention.

28

Next Steps

• Working with NICE to accredit the tool

• Developed the tool to be used within NHSE detention centres to capture experience

• Queens Nursing Institute would like to work with us to support and nurture nurses in Care Home settings 2016

• Working now to develop the possibility of residents/carers accessing a link to the tool to also offer feedback

• Adding a section to sign post staff to the frailty index tools NHSE

29

Management reporting

30

Management reporting - Overview

The feature-rich online reporting tool

provides detailed analysis of the care home

responses

• RAG reporting;

• Peer group comparison by KPI;

• Trend analysis; and

• Data export facilities.

31

RAG reporting – Individual Care Home

32

RAG reporting – Peer Group

33

RAG reporting – Individual & Peer Group

34

35

Define peer groups and compare their

performance.

Spot data trends so that appropriate action

can be taken.

www.frailtytoolkit.org 36

Supporting Nottinghamshire’s Older People with Frailty to Self-Care

The Frailty Toolkit and Training Programme

Wednesday 20th January 2016 Dr Dawn Moody

@Moody_D_K

www.frailtytoolkit.org 37

What we are going to cover

• Engaging with stakeholders to specify the requirement

• Distinctive features of the programme

• The results are so far

• What we are planning to do next

www.frailtytoolkit.org 38

Through stakeholder engagement Nottinghamshire LETC identified key local priorities

Enabling supported self-care

Multi-professional and multi-agency learning and working

Consistent education and training standards

Integrated assessment

www.frailtytoolkit.org 39

Objectives & requirements of the first phase

www.frailtytoolkit.org 40

What we are going to cover

• Engaging with stakeholders to specify the requirement

• Distinctive features of the programme

• The results are so far

• What we are planning to do next

www.frailtytoolkit.org 41

“Introduction to App is great and can’t wait to use it”

FRAILTY TOOLKIT APP

93% of training event participants said they were ‘likely’

or ‘very likely’ to share the Toolkit with colleagues

www.frailtytoolkit.org 42

I liked being able to network with other

organisations - knowing what is available

and how to access their skills

MULTI AGENCY TRAINING

EVENTS

“ ”

89% of participants said they were ‘likely’ or ‘very

likely’ to recommend training to colleagues

www.frailtytoolkit.org 43

Simple concept but works when seen

in a visual way. Good use of balance

FRAILTY FULCRUM

91% of participants rated the ease of

understanding key messages as ‘good’ or

‘excellent’ for the Frailty Fulcrum animation

“ ”

www.frailtytoolkit.org 44

Great self-care plan which is easy

to use.

SUPPORTED SELF CARE

PLAN

“ ”

I liked the supported self-care plan and

feel it would be a useful tool alongside

our own assessment plan.

“ ”

www.frailtytoolkit.org 45

Loved getting to grips with real-life

cases. Seeing the story through.

CO-DESIGNED CASE

EXERCISES

90% of participants felt the case scenarios

were an ‘effective’ or ‘very effective’ way

to achieve learning outcomes

“ ”

www.frailtytoolkit.org 46

Very innovative in looking at how impairment

affects function and, more to the point, of the

feelings associated with impairment

VIRTUAL REALITY

SIMULATION

“ ”

90% of participants felt that the VR simulation was

either ‘good’ or ‘excellent’ in terms of

helpfulness in building empathy / walking in

the shoes of an older person with frailty

www.frailtytoolkit.org 47

What we are going to cover

• Engaging with stakeholders to specify the requirement

• Distinctive features of the programme

• The results are so far

• What we are planning to do next

www.frailtytoolkit.org 48

Key facts from phase 1

300+ individuals

40+ roles 20+ organisations

92% of participants rated the training

‘very effective’ or ‘effective’ 90% of participants were “likely” or “very likely” to download, recommend or share the Toolkit and Training

Round-table networking

and multi-agency

working were the best

things about the day

Length or intensity of the

day was an issue for a small

proportion of participants

www.frailtytoolkit.org 49

• Add slide

Goal Cards

www.frailtytoolkit.org 50

Participants set themselves a range of post-training goals

21%

18%

17%

15%

11%

10%

Train&educateothers

Moreperson-centred/Findoutmoreabouttheperson/

understandingwhat'simportant

Use&share/promotethetoolkit&training

Self-careplanning/usingthedomains/integratedassessment

Promoteindependence/self-help

Involvefamilyearlier/more

www.frailtytoolkit.org 51

What’s helping and what is getting in the way?

-60 -50 -40 -30 -20 -10 0 10 20 30 40

Availablecapacity( meorresource)

Specificservicesorroles

Integratedworking

Informa onsystems-access,sharingandintegra on

Mindset

Referrals,dischargesandhandovers

Awareness,experience&knowledge

Complexity,fragmenta on,silosandduplica on

Differingexpecta ons,opinionsandtoleranceforrisk

Communica ons

Fundingarrangementsandfinancialconcerns

Approach

Policy&legisla on

Helporhinderthemesfromtrainingevents,#ofmen ons Help Hindrance

www.frailtytoolkit.org 52

Three biggest challenges for programme so far

Out of date technology has restricted access to Toolkit

Operational pressures make it difficult to release staff for training

Reaching 700+ primary care and social care providers!

www.frailtytoolkit.org 53

What we are going to cover

• Engaging with stakeholders to specify the requirement

• Distinctive features of the programme

• The results are so far

• What we are planning to do next

www.frailtytoolkit.org 54

Development of shorter training modules

• 2 hour sessions

• ….

1. Raising awareness of frailty and supported self-care

2. Case-based multi-agency, multi-professional team experience

www.frailtytoolkit.org 55

Improving access and learning as we go

• Further investment in whole-day training events

• Offer shorter sessions to “hard to reach” parts of the system

• Widen access to the online Toolkit

• Invest in maintaining Toolkit with potential for further content and functionality development

• Track and understand usage to guide future development

• Continue to work with Transformation programmes and vanguard sites to support system change

www.frailtytoolkit.org 56

In summary…